zithromax and Genital-Diseases--Male

Azithromycin was recommended as the first-line therapeutic regimen for treatment of genital infections in men and women by the Centers for Disease Control in 1998. A series of studies of azithromycin for treatment of rectal chlamydial infection in men who have sex with men (MSM) found that azithromycin was significantly less effective than doxycycline.. Literature on treatment of rectal. The available data suggests that single-dose azithromycin is not as effective as azithromycin for the treatment of rectal infection in MSM and women. Most of these data have been retrospective or from observational studies. Final recommendations will depend on the outcome of prospective, randomized, treatment studies. We may also need to examine other dosage regimens for azithromycin.

Topics: Anti-Bacterial Agents; Azithromycin; Chlamydia Infections; Chlamydia trachomatis; Doxycycline; Female; Genital Diseases, Female; Genital Diseases, Male; Humans; Male; Rectal Diseases; Sexual and Gender Minorities

To prepare the 2001 sexually transmitted disease treatment guidelines of the Centers for Disease Control and Prevention, recently published articles and abstracts concerning advances in the treatment of uncomplicated Chlamydia trachomatis genital infections in adults were reviewed. Questions about treatments were posed and answered according to the results of efficacy studies and clinical trials. Recent studies have continued to demonstrate the similar efficacy of doxycycline and azithromycin. Because compliance with doxycyline remains a concern, administration of single-dose azithromycin therapy in the clinic presents a potential advantage for patients whose adherence is questionable. Because few systematically collected data have been published concerning the safety and efficacy of azithromycin use in pregnancy, the guidelines continue to recommend treatment with erythromycin or amoxicillin. Nevertheless, because of azithromycin's less frequent side effects and improved adherence, increasing numbers of obstetricians in the United States are using azithromyin to treat pregnant women with uncomplicated C. trachomatis infections.

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Chlamydia Infections; Chlamydia trachomatis; Clinical Trials as Topic; Doxycycline; Female; Genital Diseases, Female; Genital Diseases, Male; Humans; Male; Pregnancy

To provide information for the formulation of treatment guidelines, we review recently published articles and abstracts on advances in the treatment of Chlamydia trachomatis genital infection. We ask specific questions about new treatments that are answered on the basis of the results of clinical trials and efficacy studies. New, potentially effective treatments for C. trachomatis genital infection include azithromycin and ofloxacin. Clinical studies indicate that the efficacy of these agents is equivalent to that of the current recommended agent doxycycline. Both azithromycin and ofloxacin are substantially more expensive than doxycycline. Azithromycin has the advantage of being given as a single dose, while doxycycline and ofloxacin are administered for 1 week. Issues of compliance, cost, and toxicity for specific patients should be considered when deciding whether to treat C. trachomatis genital infections with these agents.

Topics: Azithromycin; Chlamydia Infections; Chlamydia trachomatis; Doxycycline; Female; Genital Diseases, Female; Genital Diseases, Male; Humans; Male; Ofloxacin; Pregnancy; Pregnancy Complications, Infectious

The lower genital tract infections due to Chlamydia trachomatis are frequent, essentially occurring in young patients, with possible complications and severe sequela, particularly in women where the sterility risk is one of the major consequences. If an effective treatment could be systematically proposed, a good compliance (easy administration and good toleration) is one of the key factor to success. In this context, the azithromycin displays numerous advantages. The azithromycin in vitro activity on Chl. trachomatis strains is permanent with MIC comprised between 0.06 and 0.125 micrograms/ml, with an activity equivalent to those of other macrolides, to tetracyclines and quinolones. Different animal models allow to demonstrate the curative activity of the azithromycin administered as a single dose, at dosage regimen equivalent to those used in man, and a prophylactic activity on the salpingitis onset in provoked Chl. trachomatis infections. Several comparative clinical studies with azithromycin administered as a 1 g single dose displayed very satisfactory results with 98% of bacterial eradication, identical to those obtained with reference treatment. On the other hand, restrictions to the product use are a less constant activity against Neisseria gonorrhoeae and a lack of efficacy on Mycoplasma hominis. The efficacy on Treponema pallidum remains to be clinically tested.

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Chancroid; Chlamydia Infections; Chlamydia trachomatis; Female; Genital Diseases, Female; Genital Diseases, Male; Gonorrhea; Humans; Male; Mycoplasma Infections; Sexually Transmitted Diseases, Bacterial; Ureaplasma Infections

Repeat chlamydia detection after treatment is common, and there is concern that treatment failure may be a cause.. Within a randomized trial, we established a prospective cohort of 600 participants with anogenital chlamydia diagnoses (200 each of women, heterosexual men, and men who have sex with men [MSM]). Participants were invited for repeat testing at 3 months and to complete a behavioral survey at 4 months. Positive samples were analyzed for organism DNA load and genovar. We estimated repeat chlamydia positivity, reinfection and treatment failure rates, and investigated the biological and behavioral factors associated with a repeat positive test.. A total of 290 participants (100 women, 89 heterosexual men, 101 MSM) were retested at 1 to 4 months, with 43 repeat positives, including 26 classed as reinfection and 9 as treatment failures. Comparing MSM with heterosexual men and women combined, repeat positivity was higher (20.8% vs 11.6%, P = 0.04), and treatment failure was higher (6.9% vs 1.1%, P = 0.01), but there was no difference in reinfection rates (11.9% vs 7.4%, P = 0.21). Among MSM, the odds of repeat positivity increased by 90% with each additional log organism load in the original specimen (baseline) (adjusted odds ratio, 1.9; 95% confidence interval, 1.1-3.2). Among heterosexuals, the odds of repeat positivity decreased by 10% with each additional week delay in being retested for chlamydia (adjusted odds ratio, 0.9; 95% confidence interval, 0.8-0.9).. Positive retests were more common among MSM than heterosexuals. Treatment failure was more common in MSM with rectal chlamydia, reinforcing concerns about azithromycin treatment failure.

Topics: Adult; Anti-Bacterial Agents; Australia; Azithromycin; Chlamydia Infections; Chlamydia trachomatis; Female; Follow-Up Studies; Genital Diseases, Female; Genital Diseases, Male; Heterosexuality; Homosexuality, Male; Humans; Male; Mass Screening; Patient Compliance; Prospective Studies; Rectal Diseases; Recurrence; Treatment Failure; Young Adult

We conducted a randomized, unblinded, prospective study designed to determine the efficacy of single-dose azithromycin for the treatment of chancroid. Men and women 16 years of age and older who had darkfield-negative genital ulcers that were clinically suspected to be caused by Haemophilus ducreyi and who attended urban sexually transmitted disease clinics or presented to hospital emergency departments were enrolled in the study. Patients were randomized to receive 250 mg of ceftriaxone im or 1 g of azithromycin orally, both given as a single dose. They were followed for up to 23 days after treatment. For 65 patients, cultures were positive for H. ducreyi; there were 68 patients whose cultures were negative for both H. ducreyi and herpes simplex virus and who had no evidence of syphilis. All 133 patients returned for at least one follow-up visit. At the time of the last follow-up visit, all 32 patients whose cultures were positive for H. ducreyi and who were treated with azithromycin were clinically cured. In all 33 culture-positive cases in which ceftriaxone was used, there was either clinical improvement or cure at the time of the patient's last follow-up visit. In addition, azithromycin and ceftriaxone were equally effective in healing ulcers for which cultures were negative. We conclude that a single 1-g oral dose of azithromycin is as effective as a 250-mg im dose of ceftriaxone for the treatment of chancroid.

Topics: Administration, Oral; Adolescent; Adult; Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Cephalosporins; Chancroid; Female; Genital Diseases, Female; Genital Diseases, Male; Humans; Injections, Intramuscular; Male; Prospective Studies; Treatment Outcome; Ulcer

Topics: Ampicillin; Azithromycin; Genital Diseases, Male; Humans; Inflammation; Male; Urinary Tract Infections

The aim of this study was to investigate the relationships between treatment outcomes of patients with urogenital Chlamydia trachomatis infections and minimum inhibitory concentrations (MICs) and drug resistance genes.. The clinical data of 92 patients diagnosed with Chlamydia trachomatis (C. trachomatis) infections were collected. Of these patients, 28 received regular treatment with azithromycin and 64 received minocycline. All patients underwent three monthly follow-ups after the completion of treatment. The microdilution method was used for the in vitro susceptibility tests. The acquisition of 23S rRNA mutations and presence of the tet(M) gene were detected by gene amplification and sequencing.. The MICs of azithromycin, clarithromycin, erythromycin, tetracycline, doxycycline, and minocycline were comparable for isolates from the treatment failure and treatment success groups. Higher detection rates of 23S rRNA gene mutations and tet(M) were found in the treatment failure group (57.14% and 71.43%, respectively) than in the treatment success group (14.29% and 30.23%, respectively) (p < 0.05). The A2057G, C2452A, and T2611C gene mutations of 23S rRNA were detected in eight clinical isolates from the azithromycin treatment failure group, while the T2611C gene mutation was detected in one clinical strain from the treatment success group.. The detection of resistance genes could better explain the high treatment failure rate than the MIC results in patients with urogenital C. trachomatis infections, highlighting the need for genetic antimicrobial resistance testing in infected patients.

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Chlamydia Infections; Chlamydia trachomatis; Drug Resistance, Bacterial; Female; Genital Diseases, Female; Genital Diseases, Male; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Minocycline; RNA, Ribosomal, 23S; Treatment Failure; Urinary Tract Infections; Young Adult

Several studies have reported greater success of fertilisation by ART in couples who were not infected by Ureaplasma. Increased semen quality and better results have also been observed in couples who were treated with antibiotics to eradicate the infection. The aim of this study was to determine the prevalence of genital mycoplasmas in urine samples from male partners enrolled in the Assisted Reproduction Program (ARP) in our healthcare area so that, positive cases can be treated prior to the use of ART in order to increase the quality of semen, improve the embryo implantation rates and minimize the risk of adverse effects during pregnancy.. This study included couples enrolled in the ARP during 2016. Mycoplasma detection was made using real-time PCR. In positive cases, both members of the couple were treated with antibiotics until eradication of the microorganism. The antibiotics used were: azithromycin, doxycycline, levofloxacin, moxifloxacin, and clindamycin.. Of the 205 men studied, 33 were positive: Ureaplasma urealyticum 15.1%, Mycoplasma hominis 3.9%. Eradication treatment with azithromycin failed in 50% compared to 10.2% for doxycycline. Of the 5 cases treated with levofloxacin, only 2 achieved elimination of U. urealyticum.. We consider that genital mycoplasma routine screening could be useful in order to increase the quality of semen which could simplify the in vitro fertilisation procedures and raise the success rate of embryo implantation and pregnancy, especially when fast, sensitive and specific technics as real time PCR are used.

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Clindamycin; Doxycycline; Embryo Implantation; Female; Genital Diseases, Female; Genital Diseases, Male; Humans; Levofloxacin; Male; Middle Aged; Moxifloxacin; Mycoplasma hominis; Mycoplasma Infections; Prevalence; Real-Time Polymerase Chain Reaction; Reproductive Techniques, Assisted; Semen Analysis; Sex Factors; Treatment Outcome; Ureaplasma Infections; Ureaplasma urealyticum; Young Adult

To study the treatment efficacy of tetracyclines and azithromycin in Mycoplasma genitalium positive patients attending an STD clinic.. All M genitalium positive patients (34 men and 26 women) attending an STD clinic during a 6 month period were treated with antibiotics. All patients known to be partners of M genitalium positive patients and those who were M genitalium positive, but not initially treated, were treated with azithromycin. Patients with urethritis and/or cervicitis were treated with tetracyclines before their M genitalium status was known.. 10 of 14 women (71%) and 10 of 16 men (63%) treated with tetracyclines were M genitalium positive at follow up, whereas all patients treated with azithromycin (16 men and 20 women) were M genitalium negative, at the 4 week follow up visit.. These results suggest that tetracyclines are not sufficient to eradicate M genitalium. Randomised controlled treatment trials are urgently needed.

Topics: Anti-Bacterial Agents; Azithromycin; Chlamydia Infections; Female; Genital Diseases, Female; Genital Diseases, Male; Humans; Male; Mycoplasma; Mycoplasma Infections; Polymerase Chain Reaction; Tetracycline

Topics: Anti-Bacterial Agents; Azithromycin; Ciprofloxacin; Contraindications; Doxycycline; Female; Genital Diseases, Female; Genital Diseases, Male; Gentamicins; Granuloma Inguinale; Humans; Infectious Disease Transmission, Vertical; Male; Pregnancy; Pregnancy Complications, Infectious; Ulcer

Topics: Anti-Bacterial Agents; Azithromycin; Breast Feeding; Ceftriaxone; Chancroid; Ciprofloxacin; Contraindications; Erythromycin; Female; Genital Diseases, Female; Genital Diseases, Male; Haemophilus ducreyi; Humans; Male; Pregnancy; Pregnancy Complications, Infectious; Ulcer